ABSTRACT
Acute severe asthma (ASA) is characterized by severe bronchospasm refractory to the usual outpatient treatment. ‘‘Status asthmaticus’’ is generally used in reference to those episodes in which the degree of airflow obstruction is severe and not relieved by aggressive therapy within 30-60 min (1). The discussion of the standard therapy of acute asthma occurs in Chapters 18 and 19. This chapter concerns treatment of ASA and ‘‘refractory status asthmaticus,’’ a term generally reserved for those cases in which the patient’s condition further deteriorates despite aggressive pharmacological interventions. Approximately 5-10% of the general asthmatic population will experience an episode of status asthmaticus at some point (2). Of those who require intubation and admission to an intensive care unit (ICU), the mortality rates can approach 10-20% (3). Increases in the general prevalence of asthma have been recognized with a corresponding increase in cases of ASA, refractory asthma, and asthma deaths (4). Most asthma deaths are due to underrecognition and poor patient education, but some are also due to undertreatment in the acute setting (5).
